Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

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Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684090 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668409 ◽

Cited By ~ 2

Author(s):

Hao Liu ◽

Yimeng Wang ◽

Bin Pi ◽

Zhonglai Qian ◽

Xiaoyu Zhu ◽

...

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Screw Placement ◽

Thoracic Vertebrae ◽

Pedicle Screw Placement ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Computed Tomography Images ◽

Hospitalization Time ◽

Time Required

Purpose: To introduce the intraoperative O-arm-assisted pedicle screw insertion without any navigation system in the treatment of thoracic vertebrae fracture and compare it to conventional fluoroscopy (C-arm)-assisted pedicle screw insertion technique. Methods: About 156 pedicle screws were inserted in 23 patients (C-arm group), and 208 pedicle screws were inserted in 30 patients (O-arm group). The postoperative computed tomography images were analyzed for pedicle violation based on Gertzbein classification. The total surgery time, the average time required for inserting a screw, the mean action times of adjusting guide probe and pedicle screw, and the hospitalization time were compared in both groups, respectively. The American Spinal Injury Association (ASIA) was used for evaluating the health outcomes pre- and postoperatively. Results: There are the higher accuracy rate of satisfactory pedicle screw placement (grades 0 and 1) and the less incidence of medial perforation in the O-arm group compared to the C-arm group ( p < 0.05). The average time required for inserting a screw, the action times of adjusting the guide probe and pedicle screw, and the hospitalization time in the O-arm group are less than the respective ones in the C-arm group ( p < 0.05). There was no significant difference for the total surgery time between both groups. No further damage of the nerve function postoperatively is found according to the ASIA grade. Conclusion: The O-arm-assisted pedicle screw insertion without navigation we described provides higher accuracy of pedicle screw placement and better clinical efficacy compared to conventional fluoroscopy (C-arm) technique.

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In Reply to the Letter to the Editor Regarding “Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: A Systematic Review and Meta-Analysis”

World Neurosurgery ◽

10.1016/j.wneu.2020.03.196 ◽

2020 ◽

Vol 138 ◽

pp. 598-599

Author(s):

Jinpeng Du ◽

Dageng Huang ◽

Liang Yan ◽

Lequn Shan ◽

Yong Fan ◽

...

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Meta Analysis ◽

Navigation Systems ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Image Guided ◽

Letter To The Editor

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Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

European Spine Journal ◽

10.1007/s00586-010-1577-5 ◽

2010 ◽

Vol 20 (6) ◽

pp. 846-859 ◽

Cited By ~ 179

Author(s):

Nai-Feng Tian ◽

Qi-Shan Huang ◽

Ping Zhou ◽

Yang Zhou ◽

Rui-Kai Wu ◽

...

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Comparative Studies ◽

Meta Analysis ◽

Screw Insertion ◽

Pedicle Screw Insertion

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Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

European Spine Journal ◽

10.1007/s00586-009-1258-4 ◽

2010 ◽

Vol 19 (3) ◽

pp. 370-375 ◽

Cited By ~ 102

Author(s):

Rajeev Verma ◽

Sonal Krishan ◽

Kurt Haendlmayer ◽

A. Mohsen

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Pedicle Screw ◽

Meta Analysis ◽

Pedicle Screws ◽

Screw Placement ◽

Computer Assisted ◽

Pedicle Screw Placement

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123. Three dimensional printed drill guides vs fluoroscopic-guided freehand technique for pedicle screw placement: a systematic review and meta-analysis of radiographic and clinical outcomes

The Spine Journal ◽

10.1016/j.spinee.2019.05.137 ◽

2019 ◽

Vol 19 (9) ◽

pp. S60

Author(s):

Nick Wallace ◽

Bilal B. Butt ◽

Rakesh (Rock) D. Patel ◽

Ilyas Aleem

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Clinical Outcomes ◽

Meta Analysis ◽

Three Dimensional ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Freehand Technique

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An Ultrasound Technique of Bone Thickness Estimation for Pedicle Screw Insertion

Journal of Advanced Computational Intelligence and Intelligent Informatics ◽

10.20965/jaciii.2014.p0529 ◽

2014 ◽

Vol 18 (4) ◽

pp. 529-537

Author(s):

Muhamad Khairul Ali Hassan ◽

◽

Kouki Nagamune ◽

Kenichiro Kakutani ◽

Koichiro Maeno ◽

...

Keyword(s):

Pedicle Screw ◽

Cancellous Bone ◽

Pedicle Screws ◽

Screw Placement ◽

Bone Thickness ◽

Ultrasound Technique ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Real Time Measurement

Information on bone thickness is useful to surgeons in fixing pedicle screws in place. The quality of pedicle screw insertion continues to increase with the introduction of such techniques as navigation based on computed tomography and fluoroscopy. These techniques reduce error in pedicle screw placement and injury. However, the information reported on the real time measurement of depths drilled through cancellous bone, also known as trabecular bone or sponge bone, by the pedicle screw is minimal. It currently depends on palpation by the physician for judging the boundary between cortical and cancellous bone – an inaccurate technique that may produce errors in screw placement and the risk of injury during surgical processes. Ultrasound is used to help overcome such problems. Bone thickness is estimated in this study using an ultrasound transducer attached to 20 mm of polymethyl methacrylate, a clear glass-like acrylic. The bone thickness of five specimens was measured using ultrasound echo signals. Error in estimating bone thickness was small, 8.121%, showing the accuracy in bone thickness to be more than 90.00% which is suitable for use in estimating bone thickness in pedicle screw insertion.

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